Improved therapeutic options for advanced pancreatic adenocarcinoma treatment need to continue to be investigated. Since 1997, gemcitabine has been the agent of choice for first-line therapy in advanced pancreatic cancer, with a median survival of 5.7 months, and a 20% 1-year survival (Eli Lilly 1996). Combination therapies using gemcitabine as a backbone have been investigated, but none are superior to gemcitabine monotherapy, except for a modest increase in overall survival (OS) with erlotinib and gemcitabine (Moore et al 2007). In a study of FOLFIRINOX compared with gemcitabine as first-line therapy in 342 metastatic pancreatic cancer patients, median OS was 11.1 months in the FOLFIRINOX group and 6.8 months in the gemcitabine group; however, the FOLFIRINOX group experienced more adverse events particularly febrile neutropenia (Conroy et al 2011).